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Best of Crank 2017: County Presses Pause on Safe Consumption Sites

Over the next couple weeks, I’ll be hard at work meeting a big deadline (finishing up my book—eek!), so I’m re-running some posts that represent the best of The C Is for Crank in 2017. The posts I’ve chosen include breaking news, longer features, endorsements, and editorial pieces that capture the year in local news.

Of all the recommendations that came out of the King County Heroin and Prescription Opiate Addiction Task Force, by far the most controversial was the suggestion that the county authorize two supervised drug consumption sites (known euphemistically as Community Health Engagement Locations, or CHELs), where drug users could consume illicit substances under medical supervision. The idea was to prevent people from dying of overdoses, and to provide drug users with basic first aid and medical services as well as access to detox and substance use disorder treatment. In July, the county council tapped the brakes on the proposal, voting to only allow supervised consumption sites in cities that explicitly voted to allow them, and cut off access to funding for the sites, effectively “killing” supervised consumption, in the words of one longtime drug-policy reform advocate, until the end of 2018.

Two weeks ago, rejecting the unanimous recommendation of the King County Heroin and Opiate Prescription Addiction Task Force, the King County Council voted to prohibit funding for supervised drug consumption sites except in cities that explicitly approve them—a sop to suburban cities and rural areas where residents are vehemently opposed to the sites and a slap in the face for the task force, which recommended a pilot project that would include one supervised consumption site in Seattle and one somewhere else in the county. (The county refers to supervised consumption sites by the clunky acronym CHELs, for Community Health Engagement Locations).

The council also voted to prohibit the county from funding safe consumption sites anywhere outside Seattle, and barred spending any of the county’s general fund on a Seattle site. As a result of those restrictions, any money for the pilot project would have to come from the county’s Mental Illness and Drug Dependency levy—a tax that generates about $66 million a year but is already largely spoken for. The supervised consumption pilot was never supposed to be funded entirely through the MIDD, and supporters say that as the cost estimate for the pilot has ballooned to more than $1 million, the likelihood that it can be funded MIDD dollars alone is virtually zero.

“EFFECT: Restricts the General Fund Transfers to DCHS and Public Health such that 86 no General Funds can be used to establish CHEL sites. Restricts the MIDD appropriation such that no MIDD funds can be used to establish CHEL sites outside 88 the city of Seattle.” – King County budget amendment barring county spending on safe consumption sites outside Seattle

Kris Nyrop, who wrote an op/ed for the Stranger comparing the council’s move to the “state’s rights” politics of the 1980s, says the vote “effectively kills” safe consumption sites, at least for the next two years, because “The MIDD dollars are all already accounted for until the fall of 2018” and because “the [King County] health department has dithered so long on this that they have given the opposition time to really organize” against it.

Supervised consumption sites, where addicts can use illegal drugs under medical supervision in a location that also offers medical care, detox, and referrals to treatment, are common in Europe but almost unheard-of in North America, where more puritanical attitudes toward addiction have made them controversial. The idea behind supervised consumption is that it keeps people from dying of overdoses and treatable conditions (like wound infections), prevents disease transmission via dirty needles, and gets people who may not have seen a doctor in years into the health care and social service system, providing a lifeline toward housing, treatment, and recovery.

“We haven’t yet done the work that we need to do at the council to understand the proposal, the benefits, or the criteria for when and where these [safe consumption sites] make sense.” – King County Council Democrat Claudia Balducci

The sites are controversial for obvious reasons: Intuitively, giving drug addicts a safe place to consume dangerous, illegal drugs seems like condoning their behavior. (This view assumes that addiction is a choice and ignores the fact that forcing people into treatment, an alternative that safe consumption opponents frequently suggest, is cost-prohibitive and doesn’t work, but it’s ultimately an emotional argument, not a rational one.)

“Trust me, you don’t treat alcoholism by inviting alcoholics to the bar,” Republican county council member Reagan Dunn, who has been public about his own struggles with addiction, said before the vote. “Fifty-six percent of my constituents said they are extremely against these sites. Only 20 percent of people indicated they were open to considering these sites.” Dunn said he was concerned about the county’s liability if users OD and die inside the facility (in almost 15 years, not one person has died at Insite in Vancouver) and worried that the sites would become magnets for heroin dealers. He suggested that Seattle should be a test case for the site, “before we take the show on the road” to suburban areas that don’t have the same capacity to provide treatment and emergency services.

Republicans weren’t the only ones arguing that safe consumption sites should be limited to the state’s largest city. Suburban Democrats like Claudia Balducci (a former Bellevue City Council member) and Dave Upthegrove, who represents South King County, argued that the county would be overstepping its authority if it opened a safe consumption site where residents opposed the idea. “One of the things that always drove us crazy at the city level was when higher levels of government told us what to do at our city,” Balducci said. “I come from a city that has decided this is not what they want in their city. It doesn’t fit the needs or the desires of their community…. [Safe consumption sites] work best in locations where there’s a lot of street drug use,” she added.

Public Defender Association director Lisa Daugaard, who sat on the heroin task force, argues that “it sets a dangerous precedent to withhold funding for health services from residents of towns whose elected officials have ideological problems with those medical strategies. … The health and well-being of people who live in Kirkland and Kent affect that of people in Seattle, and vice versa.”

Larry Gossett, a Seattle Democrat, scoffed at the implication that drug addiction—particularly heroin addiction—is a problem restricted to big cities like Seattle. Noting that, nationally, heroin and opioid addiction is largely a rural and suburban problem, Gossett said, “I do not understand this concept that people who live outside of Seattle and in suburban and rural areas are different than people who live inside of cities.” Council member Rod Dembowski, whose district includes Shoreline, Kirkland, and Woodinville, added, “There is a serious rural crisis going on, with people dying every day, and I don’t think it’s fair to the citizens of my district to say, ‘No, you don’t get to have return on your investment’ if such a facility would serve their needs. … I don’t think the public health of the 2.1 million residents of this county should be decided based on fear.”

On the phone last week, Balducci defended her vote, arguing that the budget amendment is a temporary pause, not a permanent spending prohibition. “We haven’t yet done the work that we need to do at the council to understand the proposal, the benefits, or the criteria for when and where these [safe consumption sites] make sense,” she said. “We have to do a little more background work and figure out, what are these [safe consumption] sites and who do they serve.” Balducci also suggested that a huge debate about safe consumption sites could blow up her ongoing efforts to establish the first permanent men’s shelter on the Eastside in Bellevue. “We are facing a really tremendous backlash about that, and one aspect of the opponents’ position is that this is just the camel’s nose under the tent and they’re going to legalize heroin next and [addicts] are going to be out in all the neighborhoods.”

Of course, they’re already there.

Daugaard, who still holds out hope that the council could reverse its decision during the ongoing budget process, says that if they don’t, “it will be very difficult to keep the promise that the heroin task force made to neighborhood leaders in Seattle: that Seattle would not be left alone to respond to this need, which is fundamentally unfair given the widespread use of heroin and opiates throughout the county. Waiting until 2019 to move forward inevitably will mean avoidable overdose deaths, and no solution to drug use in unsupervised public sites like bathrooms and parks. Hopefully we all can agree that the status quo is unacceptable. Waiting is not a plan.”

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